Health Access California presents a March 2015 update of the state Medi-Cal program, how it's changed, and upcoming issues over the next year.

1. AnthonyWright
March 2015
www.health-access.org
www.facebook.com/healthaccess
www.twitter.com/healthaccess

2.  A half-century of covering Californians, since 1966.
 About 12 million people enrolled; 1/3 of the state
 Key financing mechanism for virtually all CA hospitals
 Over 40% of births, Over 66% of nursing home care
 Hard to overstate its importance & centrality to our
health care system we all rely on.
Medi-Cal not just expanded but transformed
 Expansion of coverage requires renewed focus on access
to care & improved quality and equity
 Needed investments and accountability are crucial to
continuing the progress to an improved health system

3. Biggest Congressional Action for Consumer Protections; Coverage Expansion; Cost Containment

4.  Governor’s 2015-16 Budget: $95.4 Billion for Medi-Cal
 General Fund: only $18.6 Billion of $113 Billion Overall Budget
 Federal Funds: $61.6 Billion
 Other Funds $15.2 Billion (like provider tax)
 ACA-related expansion: 3 million Californians covered:
 2 Million newly eligible (100% federally funded; 90% in 2020 and beyond)
 1 Million previously eligible (50% federally matched)
 $18 Billion: $17 Billion federal funds, $950 Million general fund
 1 Billion offset from provider tax, AB85 county reallocation
 Currently, no general fund cost for this historic expansion

5.  Medi-Cal no longer just a collection of categorical programs for
children, parents, seniors and people with disabilities, but a safety-
net for virtually all of us (excluding undocumented).
 Some of the newly-coverage are entirely new to coverage: low-
income working adults, homeless, recently incarcerated, others.
 Expansion & elimination of assets test means Medi-Cal is now
available as a safety-net for:
 Middle-class families between jobs
 College students and those going back for education/training
 Early retirees
 Medi-Cal must respond to a new range of expectations;
Demand-driven change

8.  Making Signing Up Easier
 Not Just an IT Glitch: LastYear’s 900,000+ Enrollment Backlog
 Conflicting, Confusing Notices
 Fixing CALHEERS & the 24-Month Roadmap
 Former FosterYouth
 Consumer Experience Needs to Be Improved
 The Need to Limit Estate Recovery
 California: only one of 10 states that requires estate recovery for
Medi-Cal managed care applicants aged 55+.
 Raises little revenue, major barrier to enrollment, inequitable.
 Governor vetoed bill last year; pointed to budget process;
SB33(Hernandez) this year. Senate Health Hearing March 25th

10. 10
 Continuing California’s Coverage of “Deferred Action” Immigrants:
The President’s executive action had the impact of expanding the
category of immigrants covered by state-funded Medi-Cal. We need
to defend and secure this major victory. Also:
 Secure and Expand our County Safety-Net Programs: Counties are
the last resort of coverage. DespiteAB85’s reallocation, some
counties are enhancing their safety-net for the remaining uninsured,
with programs like My Health LA.Through the Medi-Cal waiver, we
need to encourage more counties to care for the undocumented.
 Making Progress to a Statewide Solution for #Health4All: An effort
now in its third year, we can take another step to Health4All,
expanding Medi-Cal to more immigrants, and setting up the
structure for a mirror marketplace so everyone can seek coverage.

11. LOS ANGELESTIMES:
“Study sees modest costs in healthcare for
immigrants here illegally”
By Patrick McGreevy * May 21, 2014
 Increased health of poorCalifornians could reduce costs down
the road, study says
Extending healthcare to people in the country illegally would cost the state a modest amount more
but would significantly improve health while potentially saving money for taxpayers down the road,
according to a study released Wednesday.
The study by the UCLA Center for Health Policy Research estimates that the net increase in state
spending would be equivalent to 2% of state Medi-Cal spending, or between $353 million and $369
million next year, while the net increase in spending would be up to $436 million in 2019.
Enrollment in Medi-Cal would increase by up to 730,000 people next year and up to 790,000 in four
years.

13. Benefits
 In 2009, 10 benefits were cut from Medi-Cal
 Partially restored dental coverage
 Need to fully restore the package of benefits, from vision to
podiatry.
 Comparatively not that much money
Rates & Access to Care
 In 2010, AB97 cut Medi-Cal fee-for-service rates by 10%; some
adjustments by CMS but still not restored;
 ACA included a 2-year primary care rate bump to Medicare
levels; 73% increase nationally, around double in CA; Bump
expired in the new year, January 2015

14. 14
51%
66%
0%
20%
40%
60%
80%
100%
120%
140%
RhodeIsland
NewJersey
California
Michigan
NewYork
Florida
NewHampshire
Missouri
Ohio
Illinois
Indiana
Hawaii
Texas
Maine
US
Pennsylvania
Minnesota
Colorado
Maryland
Nevada
Utah
Georgia
Louisiana
Washington
SouthDakota
Wisconsin
Massachusetts
Kentucky
Alabama
Kansas
Arkansas
Virginia
WestVirginia
DistrictofColumbia
Vermont
Oregon
SouthCarolina
Arizona
Iowa
NorthCarolina
Connecticut
Nebraska
Idaho
Mississippi
NewMexico
Montana
Oklahoma
Delaware
Wyoming
Alaska
NorthDakota
MedicaidFee-for-ServicePaymentstoPhysiciansasaPercentage
ofFederalMedicarePaymentsfortheSameServices,2012 California'sMedicaidPaymentstoDoctorsAreAmongtheLowestintheNation
Note: Datareflect fees for primary care, obstetric care, and other services. Tennesseeis
excluded because its Medicaid programdoes not haveafee-for-service component.
Source: Kaiser Family Foundation
California Budget Project Slide
Medi-Cal Fee-for-Service Payments A Low % of Medicare

15. One of the lowest
Medi-Cal
reimbursement
rates in the nation.

16. 16
57.1%
69.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NewJersey
California
Florida
Connecticut
Tennessee
NewYork
Louisiana
Illinois
Maryland
Colorado
Oklahoma
Georgia
Missouri
Pennsylvania
Kansas
Alabama
RhodeIsland
US
Hawaii
Texas
Indiana
Ohio
Maine
DistrictofColumbia
Nevada
Virginia
Washington
NorthCarolina
Delaware
Vermont
Arizona
Kentucky
Oregon
Mississippi
Massachusetts
WestVirginia
Michigan
NewHampshire
Alaska
Utah
SouthCarolina
Idaho
NewMexico
Nebraska
Iowa
Montana
Arkansas
Wisconsin
SouthDakota
NorthDakota
Minnesota
Wyoming
PercentageofOffice-BasedPhysiciansAcceptingNewMedicaidPatients,2011
CaliforniaHastheSecond-LowestShareofDoctorsAcceptingNewMedicaidPatients
Source: USCenters for DiseaseControl and Prevention
California Budget Project Slide
Fewer CA Doctors Accept Medi-Cal Patients

17. Gaps in Realized Access
Use of Care Measures
* Did not have a doctor visit in the prior year
37% Medi-Cal; 30% Medicaid in other states (CHIS: 16% Medi-Cal, 13% ESI)
* Did not have a specialist visit in the prior year
48% Medi-Cal; 36% Medicaid in other states
* Did not have a dental visit in the prior year
59% Medi-Cal; 47% Medicaid in other states
* Did not have a flu vaccination in the prior year
71% Medi-Cal; 66% Medicaid in other states (CHIS: 69% Medi-Cal; 62% ESI)
* Among women 18 and older, did not have a Pap test in the prior year
42% Medi-Cal; 38% Medicaid in other states
* Delayed needed medical care because of difficulty getting an appointment in the prior year
12% Medi-Cal; 8% Medicaid in other states
* Had two or more emergency room visits in the prior year
15% Medi-Cal; 17% Medicaid in other states (CHIS: 14% Medi-Cal, 11% ESI)
* Most recent emergency room visit in the prior year was because doctor’s office not open
6% Medi-Cal; 9% Medicaid in other states
2011-12 National Health Interview Survey

19. Medicaid matters:
 Even early results of Oregon study shows increased use of a regular
place of care, a usual doctor and use preventive care; and improved
mental health, and financial benefits to having coverage.
 69% said “Medi-Cal provides access to high quality medical care.”
(CHCF)
But access issues remain:
 Clear that Medi-Cal patients don’t have the same access as others
to doctors and specialists.
 Issues arise, as expected, with patients with specific needs; with
specialists; exacerbated in certain rural/urban geographic areas.
 Can’t risk issues getting worse with a rate cut during expansion.

20.  The promise of “coordinated care” is that Medi-Cal is no
longer “a license to hunt,” but a guarantee of access to
needed care and adequate networks.
 Managed care plans (including Medi-Cal managed care)
are supposed to meet timely access to care standards.
 Department of Managed Health Care has set time
standards, including 10 days for a doctor or specialist
appointment.
 SB964(Hernandez), sponsored by Health Access and
passed last year, requires annual reviews of network
adequacy, by lines of business, including Medicaid
managed care plans.

21. Health Access California Goals:
 More federal $ for a safety-net that survives and thrives
 Improved/coordinated access to remaining uninsured
 Incentives that work for patients on cost/quality/equity
 Better integration with human services

22. “Waiver renewal is critical to ongoing success, viability and long-
term sustainable change of the Medi-Cal Program.”
STRATEGIES
* Public Safety-Net System Global Payment for the RemainingUninsured
* DeliverySystemTransformation & Alignment Program
• Managed Care SystemsTransformation & Improvement Program
• Fee-for-ServiceTransformation & Improvement Program
• PublicSafety-Net SystemTransformation & Improvement Program
• Workforce Development Program
• Increased Access to Housing and Supportive Services Program
• Whole Person Care Pilots
FINANCING
* State-Federal SharedSavings and Reinvestment
* Budget Neutrality
* Continued Federal Funding Support

23. March 27, 2015 •Target submission date ofWaiver application
April – Nov. 2015 • DHCS/CMS discussions
May 20, 2015 • Stakeholder Advisory Committee update
Spring/Summer 2015 • Collaborative program development with
stakeholders
July 22, 2015 • Stakeholder Advisory Committee update
Fall 2015 • Final STC development
Nov. 1, 2015 • Start of new Waiver
Post-Approval • Continued stakeholder engagement forums

24. Website: http://www.health-access.org
Blog: http://blog.health-access.org
Facebook: www.facebook.com/healthaccess
Twitter: www.twitter.com/healthaccess
Health Access California
1127 11th Street, Suite 234, Sacramento,CA 95814
916-497-0923
414 13th Street, Suite 450, Oakland,CA 95612
510-873-8787
1930Wilshire Blvd., Suite 916, Los Angeles,CA 90057
213-413-3587
Much thanks to the California Budget Project, the California HealthCare
Foundation, and the UC Berkeley Labor Center for use of their slides.